Friday, June 8, 2018

Legislative Initiatives Poised to Benefit EMS in Three States

PA, NY and MD

State lawmakers in Pennsylvania, New York and Maryland have been working on new legislation that has the potential to drastically change the EMS reimbursement landscape.

Legislative Initiatives Poised to Benefit EMS in Three States

This year has seen a flurry of activity in the chambers of government across these States as fire and EMS advocates are sounding the alarm regarding stagnant reimbursement rates that are failing to keep pace with the growing costs to provide EMS services.

While Pennsylvania and New York lawmakers are still considering future passage of their initiatives, their counterparts in Maryland have successfully pushed legislation that has now been signed into law by that States governor.

Maryland Senate Bill 682

On May 15th, Governor Larry Hogan signed into law Senate Bill 682. The new law will be enacted officially on July 1st.

This new law charges the Maryland Institute of Emergency Medical Services Systems (MIEMMS) and the Maryland Health Insurance Committee to initiate a 6-month study for report back to the State Legislature to devise a plan that will require commercial insurance payers and Maryland Medical Assistance to pay for the following…
  • Mobile Integrated Health Care (MIHC)
  • Treatment of a patient on the scene but with no transport required
  • Transport of a patient to an alternative location that is not a hospital destination
The bill calls for a comprehensive plan to be submitted as part of the report including a plan for how such reimbursement will be obtained from the Medicare program, as well.

Under consideration, as part of the study, is for the Maryland Medical Assistance program to initiate a rule change so Medicaid payments can begin on January 1st. The Medicare issue, while tied up in Federal initiatives may be tackled under a waiver program set to take effect also on January 1, 2019 which includes a “total cost of care” initiative.

Pennsylvania Senate Bill 1013 / House Bill 699

Legislation spearheaded in Pennsylvania by a State lawmaker with direct EMS ties has been passed just this week in the Pennsylvania Senate. Senate Bill 1013 was approved by the upper chamber, putting into motion a series of events that will require Pennsylvania Medicaid and commercial insurers to reimburse EMS agencies when emergency treatment is provided at the scene but transportation is not required.

State Representative Martin Causer of the 67th Legislative District encompassing Potter and McKean Counties in the Bradford and Coudersport areas of the State is leading the rally complete with House Bill 699. Causer, a former EMS provider himself, has been a champion for this legislation. This week he organized a rally of EMS representatives in Harrisburg which later resulted in the passage of SB 1013.

HB 699 takes another pathway to improving reimbursements for Pennsylvania’s ambulance industry. The bill proposes a 50% increase in Pennsylvania Medicaid reimbursements, which would be only the second such fee update since Medicaid began reimbursing for ambulance transportation in Pennsylvania.

As the overall discussion of the thinning ranks of fire and EMS personnel in Pennsylvania gains traction, these initiatives at the State government level will help ease some of the concerns for EMS administrators across the Commonwealth.

New York S0363 / A7717b

With a heavy push by the Fireman’s Association of the State of New York, the New York State Association of Fire Chiefs and the County Fire Coordinators Association of the State of New York, two bills have been introduced that are mirrored in nature. In the Senate S0363 and in the Assembly A7717b were introduced earlier this year with focus on allowing Fire Departments in that State to recover the costs of EMS services.

The move has gained traction as championed by several North Country lawmakers who growingly have become concerned regarding fire departments in that geographic corner of New York expressing concern over growing budget shortfalls when providing ambulance services.

New York State has always had a moratorium in place prohibiting recovering reimbursement for EMS services by fire departments. For perspective, consider that of the 1,025 ambulance services in New York State, 468 of them are fire-department based accounting for 300,000 calls for service each year.*

The legislation has gained considerable headway over the past several weeks with the Senate moving S0363 into both the Local Government and Finance Committees while the State Assembly has Advanced A7717b through to their Local Government committee.

Every Penny Counts

We all know that every penny counts. Lawmakers are faced with the pressure of passing initiatives that will support vital emergency services while at the same time balancing a tight revenue stream that does not inordinately raise taxes for their constituents.

We will continue to follow these important pieces of legislation as they advance in these States. Certainly, there will potentially be other State lawmakers across the nation who will look to their counterparts for the overall outcome.

*The article, ”Bill would allow fire departments to recover costs of EMS services” published by The Legislative Gazette on 5/22/2018 is the source for New York State ambulance service statistics reported above.

Friday, May 25, 2018

Ordinary People Doing Extraordinary Things


You are amazing!

You- yes, you…Mr, Ms, Mrs…paramedic, EMT, nurse, doctor….ground-, air-based…you are amazing!

In case no one told you that in the last week as we celebrate EMS, please allow all of us here at Quick Med Claims to pat you on the back and call you out for the hero that you are.

It Doesn’t Matter…

It really doesn’t matter what role you play nor how long you’ve been involved in EMS. You matter! You are a big deal!

From the folks in the air, on the street to those in the office and especially those of you who volunteer by giving your time, knowledge and expertise in whatever role you play; just know that while you may not hear this every day from those you serve- they definitely appreciate you.

We appreciate you!

Look How Far…

Look how far EMS has come.

As first responders to all things medical transportation-ish we have made enormous strides. Everyday lives are saved because those who came before us were willing to think outside of the box and come up with new ways and new equipment, and might we say new money, to develop a constantly evolving and every-changing new system to make this all happen.

Our list of incredible “toys” has grown, but more importantly you all have grown. The skill and education that today’s EMS requires is mind-boggling. It takes you to make that cardiac monitor transmit a digital image to the ER doctor. It takes you to properly apply the Lucas Tool to deliver flawless and consistent chest compressions. It takes you to get the IV started in a moving vehicle with potholes and bumps and turns and twists, administer the correct medication in just the right dosage that saves the life and preserves a family yet another day.

Maybe you’re the new Community Paramedicine paramedic. Your visit to Mrs. Jones’ house to look in on her may just be the only visit she receives today. You leave with the satisfaction that this widow can rest knowing she has achieved her health goals for the day plus she’s a bit less lonely for your having stopped by. Mobile Integrated Healthcare at its finest and you’re the pioneer on the forefront.

We can go on and on…you know who you are.

The Nasties!

On TV, the Station 19 crew always has the “big one” and it always works out in the end.

Fast-forward…real world…not so much.

For every “big one” there are ten “not-so-big-ones”…like the trip from the ER discharging to the SNF. Or there’s the guy who had a few too many tall ones that pukes on your nicely mopped ambulance floor which now you’ll mop and disinfect again.

There’s the brand new uniform pants that now has blood on them and it won’t come out.

There’s the overdose victim that lives for another day because of that vial (or two) of narcan the wonder drug that you just administered and while you feel relieved that he lives, somehow you know that you’ll be back again tomorrow at the same location for the same patient. So…you provide a bit of fatherly/motherly advice; “Get help!”…and yet help evades these people over and over.

But you keep going. Though the nasties, through the routines and the not-so-routines.

You keep going on and on missing lunch, stretching those bathroom breaks to the point of explosion and you do it on two hours sleep here and there. Along the way, you struggle to take care of yourself- try to eat right, try to forget, try to cope and yet you still feel the rush when you know that you completely stood up to death and you won!

Unless you do it…

From the billing office window, we are in awe of you. We see first-hand what you do and are continually amazed at your accomplishments. You are a true superhero in every sense of the word.

Unless you do this thing that we all do, be it in the office or in the field; few people outside of the first-responder world will ever really “get” why and how you do it. To them you may just be an “ambulance driver” but to us you truly walk on water.

But, what really amazes us is the fact that you take it all in stride. It’s another “day at the office” and yet countless people enjoy another day of life because of YOU! That’s a big deal!

THANK YOU! As we close out this EMS week, we truly say THANK YOU!

You rise with humanity to permanently impact the lives of everyone you touch. The debt of gratitude that society owes you is immeasurable.

Be safe! Happy EMS Week!!

Friday, May 11, 2018

The Moms of EMS- A Tribute


Sunday’s a big day!

It’s Mother’s Day. It’s a day that we celebrate the one person we literally cannot do without simply because…well…we physically wouldn’t be here without our moms.

And…that got us thinking about the Mom’s that make up EMS. What will their Sunday look like?


It’s all about the alert!

You know, the dispatch. Whether it be a Minitor chirping, an alpha-numeric pager tripping or the Active 911 blast across the cell phone screen, it’s bound to interrupt mom’s day.

Many of our EMS moms are volunteers. The person with an emergency will pay little mind to the fact that Sunday, Mother’s Day, is set aside to honor those EMS moms. The heart attack, stroke, motor vehicle crash…unfortunately, does not know that this day is meant for rest, relaxation and pampering.

It happens and almost always just when we all sit down for a nice meal or meaningful conversation with that mom. Maybe it’s the daughter who just sat down to tell mom how important she is and off trips the pager. Maybe it’s the mom who just welcomed her son for a Mother’s Day visit but Mrs. Smith down the street fell and needs EMS.

Off runs mom to answer the alert and everyone at home is just going to need to sit tight and wait for mom to return to celebrate Mother’s Day.

Career Shift

An EMS mom can be a career staffer at your community ambulance service. Sunday is her day to work regardless of whether or not the calendar says it’s Mother’s Day.

Hallmark card aside, today is a work day. There are lives to save and people to move.

So, off to work mom goes. Maybe her Mother’s Day was the day before or maybe it will be Monday, the day after.  But, duty calls and since EMS never takes a day off “the show must go on.”

Supporting Cast

EMS moms aren’t just limited to the providers. Think about all of the moms of EMS that work in the office.

Near and dear to our heart, here in the billing office, are all of the moms that fill our incredible billing chairs. These ladies (and men- but today we celebrate the moms) work diligently to support the field operations. Without their tireless work there would be little to no financial resources to support those vital field ops. Take these ladies out of the equation and the EMS machine would grind to a screeching halt because there would be no financial fuel to keep things humming.

On top of the billers, there are those moms that sit on boards of directors, take care of human resources, pay the bills, order the supplies and…on and on and on.

The Multitaskers

In this tribute to our EMS moms, we recognize the moms who are the multitaskers.

In our opinion, EMS moms- more than most- bring multitasking to a whole new level. Before and after moving patients, they move a lot of people and “stuff.”

The EMS mom moves her family on the heels of moving her patients. There are little people to move to soccer practice, dance recitals or music lessons. The groceries must be purchased, loaded, unloaded and the food must be prepared (or McDonalds must be retrieved for those pressed for time.)

The bills at home must be paid, clothes washed, sleepy people to be roused and then there’s (maybe) time to fall into bed and do it all over again- that is unless mom’s shift at the ambulance station is third shift.

EMS thrives on many tasks, constant activity and little sleep. We’re of the opinion that the EMS mom is THE BEST at this over any mom created. God gave special super-human skill and ability to the EMS mom…and it shows.

Take a Bow!

In closing, will the EMS mom reading this post please…TAKE A BOW!

You’ve earned our highest respect and admiration. You are the embodiment of the Super Mom!

Thank you to those of you who make the time to be awesome in the role you play to protect the life and health as part of the EMS system.

Sunday’s YOUR day.

Happy Mother’s Day!

Friday, May 4, 2018

Emergency! – Digging Deeper to Define

Bloggers Note- this week our billing office had a discussion with a client to help provide direction on the question of what constitutes an emergency and the documenting of the use of “lights and sirens”. The discussion is common. Just about two years ago, we added a blog post that addressed this very subject, so we thought it would be a good idea to resurrect that post and remind everyone of the rules. We hope you enjoy the content.
Lights and Sirens Myth
This billing office is often questioned about what constitutes an emergency for the purposes of billing and collecting payment.

There’s a myth in EMS that any ambulance incident that necessitates the use of “lights and sirens” is an emergency. It’s not the case.

Emergency! – Digging Deeper to DefineWe look to Chapter 10 of the Medicare Benefit Policy Manual as published by the Center for Medicare and Medicaid Services (CMS) for the definition most widely used. Surprise! There isn’t a mention of lights and sirens anywhere in the definition.

We need to know…

Whether you’re an EMS field provider, an EMS administrator or both it is important that you know and understand the definition of what constitutes an emergency in the ambulance billing world. We argue that many of our street-level providers are never adequately schooled on the rules, yet we expect them to provide pinpoint documentation regarding their emergency scenario when they have no clue on how to tell the billing office what it is they need to tell us in order to define the scenario as emergency or non-emergency.

In the world of the street provider, you turn on the light, hit the siren and get a move on- that’s an emergency.

Not so for billing later.

The Definition

CMS defines an ambulance “emergency” as…
An emergency response is one that, at the time the ambulance provider or supplier is called, it responds immediately. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.
In explaining the application of the definition, CMS further elaborates…
The determination to respond emergently with a BLS or ALS ambulance must be in accord with the local 911 or equivalent service dispatch protocol. If the call came in directly to the ambulance provider/supplier, then the provider’s/supplier’s dispatch protocol must meet, at a minimum, the standards of the dispatch protocol of the local 911 or equivalent service.
Again...specifically noting for emphasis…not a single mention of lights and sirens.

Let’s pick it apart…

Looking at the definitions and application instructions above, what is it that is required to be in the Patient Care Report documentation in order to affirm to the payer that the trip can be billed as an emergency?

First, make sure that everyone is documenting how the dispatch was received. Most likely it has been received via the 9-1-1 public service access point (PSAP). You’ll find above that the rules do allow for what we all refer to as a “direct call” when the office phone rings at the station as opposed to a 911 center but it should be stated in the PCR that the call was emergent or life threatening in nature. For the regular phone to ring with an emergency requires that the ambulance office where the phone is answered follows the same protocols as the nearest 911 center which necessitates some set-up behind the scenes (another blog, another time).

Second, we must be sure to educate the provider staff about documenting the response. Notice the rule spells out that the ambulance crew “…must begin as quickly as possible to take the steps necessary to respond to the call.” A standard alert-to-response time frame, such as in a volunteer-staffed ambulance scenario or where there are complicating factors such as inclement weather, etc., simply needs to be explained in the written narrative.

Documenting the means of dispatch (911 or equivalent) and documenting the “immediate” response are the two big ticket items that must be clearly spelled out in the Patient Care Report to enable your billing office to properly bill the EMS scenario out as an ALS or BLS emergency.


Finally, if possible it never hurts to include documented verification from the 911 center. Many systems are now providing Computer Aided Dispatch (CAD) recaps which can either be electronically scanned and attached into an ePCR system or appended to the written documentation to be passed-on to the billing office. Having this information available is proof-positive of the nature of dispatch and even backs-up the response times of the scenario.